Physical activity is extremely important for the overall health of an individual, including physical, mental, emotional, and social benefits. Physical activity is especially important for older adults in the prevention of chronic disease, combat the normal physiological processes of aging, maintenance of functional capabilities, psychological benefits, and improved quality of life. It is important to understand the most recent general recommendations for physical activity for the older adult population so that we can best help promote the health, wellness, and vitality of this population.
Objectives:
1. Outline the general exercise recommendations for older adults ages 65 and older regarding aerobic exercise, strength training, and flexibility & balance activities.
2. Provide information and resources to aid in determining level of intensity of aerobic exercise, as this can be difficult for individuals to quantify without resources available.
3. Overview general recommendations for strength training for older adults, aimed at reducing the degree of under-loading this population often suffers from.
4. Provide brief understanding of general benefits of exercise for older adults, strength of recommendations for different paradigms of exercise training and related domains of health, and provide additional resources to further understand the multifaceted benefits of exercise for the older adult population.
CDC Guidelines for Physical Activity for Older Adults ages 65 and older:
Older adults need at least:
150 minutes of moderate intensity aerobic activity per week (2.5 hours total per week, or 30 minutes 5x per week), OR 75 minutes of vigorous intensity aerobic activity per week (75 minutes total per week, or 25 minutes 3x per week)
Completed in bouts of at least 10 minutes each
An equivalent mix of moderate and vigorous intensity is also acceptable!
Even greater benefits from 300 minutes of moderate intensity aerobic activity per week or 150 minutes of vigorous intensity aerobic activity per week.
2 days per week of muscle strengthening activities to target all major muscle groups (legs, hips, back, core, chest, shoulders, arms). 8-12 repetitions of 8
Balance and flexibilty exercises should be included at least 3 days per week
It can be difficult for individuals to determine what constitutes "moderate" or "vigorous" intensity activity. Although objective measures can be used in clinic (provided patient is not on medications or has condition that makes HR response to exercise unreliable, i.e. beta blockers or post-heart transplant), teaching patients how to gauge the intensity of their exercise on a subjective rating scale (i.e.: RPE scale, dyspnea scale, "talk test") is a valuable tool that can be utilized both while you are working with them and while they are exercising on their own. Here are a few resources to utilize with individuals to help them gauge their intensity level:
Moderate intensity= on a 0-10 modified Borg Rating of Perceived Exertion (RPE) Scale where 0=sitting and 10=all out maximum effort), a 5-6 correlates to moderate intensity. On 6-20 Borg RPE scale, approximately 11-14 is considered moderate intensity.
Vigorous intensity= on the 0-10 modified Borg RPE scale, a 7-8 correlates to vigorous intensity. On 6-20 Borg RPE scale, above a 15 is vigorous intensity.
NOTE: Keep in mind you may have to alter relative/absolute intensity of exercise based on any existing conditions or comorbidities that an individual may have. It is very important to take a thorough history prior to initiating exercise program or determining appropriate intensity. Determine if the patient has been cleared for exercise by their physician. Additional tool that can be helpful in determining safety in initiating exercise program for older adults under 70 yo is the PAR-Q & YOU. Older adults 70 and older will benefit from a screening prior to initiating exercise program to ensure safety.
Brief Overview of Strength Training Principles for the Older Adult
Older adults often suffer from under-loading within our current paradigm of care. It is well understood based on the literature regarding mechanotransduction (Mechanotransduction mechanisms) and the overload principle that we must overload tissues in a controlled manner in order to create mechanical adaptations, but we often fall short to execute this in the older adult population when prescribing exercise, particularly resistance exercise. According to Avers and Brown in their White Paper regarding strength training for the older adult (source), a minimum weight of 60% 1 Rep Maximum (RM) is required for any significant gains in strength in the older adult population, with the optimal being 80-85% 1 RM for physiological adaptations that correspond to improvements in strength and function. When considering safety of 1 RM testing in this population, we must consider the work of Richard Fabio, who identified that it is indeed safe in many clients in the older adult population (source) (in his research, even in patients with high-risk cardiac and pulmonary conditions with no adverse events). In the event that the therapist is simply not comfortable performing a 1-RM testing protocol on their older adult patient, there are other methods to determine a 1-RM that do not require maximal loading, including performing a 10-RM test and then utilizing a chart to determine the patient's 1-RM weight. The therapist can then use this estimation to determine appropriate loading during exercise session.
When performing strength training with the older adult, it is also very important to consider different loading parameters for different adaptations. For example, when focusing on muscle strength, working at a lower volume of repetitions (3-8 reps) at a higher weight (60-85% 1-RM) is most effective. When focusing on endurance, higher volume (8-20 reps) at a lower weight (<60% 1-RM) is most effective. Additionally, we cannot forget to include power training in the older adult population, as there is a tremendous link between declines in lower extremity power and physical function & fall risk alike. In a 2003 study by Miszko et al, (source) it was found that the community-dwelling older adults in the power- training group demonstrated greater improvements in physical function than those in the strength training group. To maximize gains in power, training stimulus should be aimed at low volume (1-5 reps) of high load (60-85% 1RM) at maximum speed. Practical examples may include training a sit-to-stand with specific instructions to "explode" up from the chair as fast as possible, potentially adding weight depending on the individual's strength.
Benefits of Exercise for the Older Adult
Although it is not the intent of this particular Wiki to highlight in detail all of the benefits of physical activity for the older adult population (as that would constitute an entire Wiki of it's own), one extremely beneficial resource in understanding all benefits of physical activity in this population is the ACSM Position Stand on Exercise and Physical Activity for Older Adults . Two graphics that highlight the benefits of exercise to combat chronic diseases, that are increasingly more prevalent as we age, as well as strength of recommendations and rationale for various concepts are below:
In general, the benefits of regular physical activity for older adults includes, but is not limited to:
Reduced risk for chronic diseases that lead to premature death and disability
Combat age-related physiological and functional declines that occur naturally during the aging process across many systems of the body, including changes in cardiorespiratory work capacity, body composition and muscle mass, alterations in neural pathway strength and signaling, changes in brain mass and functioning, etc.
Delay/reduce risk of functional decline
Reduce risk of atrophy/sarcopenia
Reduce risk of falls related to decreased strength, power, and balance capabilities
Improved bone mineral density, reducing risk for osteopenia/osteoporosis
Improved quality of life
Mental and emotional health benefits
Social health benefits, particularly when exercise is performed in a group atmosphere
Decreased risk of frailty
Increased independence, promoting ability to "age in place"
Many more!
Conclusion: Encouraging older adults to engage in regular, guideline-adherent physical activity is supremely important for their total health, wellness, and quality of life. It is our responsibility as healthcare providers to be well-versed in the recommendations for physical activity in this population so that we can be front-line providers that facilitate the implementation of exercise programs in the older adult population across our nation.
6. Fabio, R. P. (2001). One Repetition Maximum for Older Persons: Is It Safe? Journal of Orthopaedic & Sports Physical Therapy,31(1), 2-3. doi:10.2519/jospt.2001.31.1.2 7. https://uic.pure.elsevier.com/en/publications/exercise-and-physical-activity-for-older-adults 8. Bauman, A. (2004). Health benefits of physical activity for older adults – epidemiological approaches to the evidence. Optimizing Exercise and Physical Activity in Older People,1-25. doi:10.1016/b978-0-7506-5479-1.50004-2 9. Batavia, M. (2006). Strength, Power, and Endurance Training. Contraindications in Physical Rehabilitation,154-202. doi:10.1016/b978-141603364-6.50019-7
Objectives:
1. Outline the general exercise recommendations for older adults ages 65 and older regarding aerobic exercise, strength training, and flexibility & balance activities.
2. Provide information and resources to aid in determining level of intensity of aerobic exercise, as this can be difficult for individuals to quantify without resources available.
3. Overview general recommendations for strength training for older adults, aimed at reducing the degree of under-loading this population often suffers from.
4. Provide brief understanding of general benefits of exercise for older adults, strength of recommendations for different paradigms of exercise training and related domains of health, and provide additional resources to further understand the multifaceted benefits of exercise for the older adult population.
CDC Guidelines for Physical Activity for Older Adults ages 65 and older:
Determining Aerobic Exercise Intensity
METS by activity
Charts from: https://www.bewegenismedicijn.nl/files/downloads/acsm_position_stand_exercise_and_physical_activity_for_older_adults.pdf
Conclusion: Encouraging older adults to engage in regular, guideline-adherent physical activity is supremely important for their total health, wellness, and quality of life. It is our responsibility as healthcare providers to be well-versed in the recommendations for physical activity in this population so that we can be front-line providers that facilitate the implementation of exercise programs in the older adult population across our nation.
References:
1. Pate, P. R. (1995, February 01). Physical Activity and Public Health. Retrieved July 01, 2017, from http://jamanetwork.com/journals/jama/article-abstract/386766
2. How much physical activity do older adults need? (2015, June 04). Retrieved July 01, 2017, from https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm
3. ACSM Position Stand. (2000). Nutrition and the Strength Athlete Nutrition in Exercise & Sport,265-270. doi:10.1201/9781420036923.axc
4. http://scholarcommons.sc.edu/cgi/viewcontent.cgi?article=1361&context=sph_epidemiology_biostatistics_facpub
5. Avers, D., & Brown, M. (2009). White Paper. Journal of Geriatric Physical Therapy,32(4), 148-152. doi:10.1519/00139143-200932040-00002
6. Fabio, R. P. (2001). One Repetition Maximum for Older Persons: Is It Safe? Journal of Orthopaedic & Sports Physical Therapy,31(1), 2-3. doi:10.2519/jospt.2001.31.1.2
7. https://uic.pure.elsevier.com/en/publications/exercise-and-physical-activity-for-older-adults
8. Bauman, A. (2004). Health benefits of physical activity for older adults – epidemiological approaches to the evidence. Optimizing Exercise and Physical Activity in Older People,1-25. doi:10.1016/b978-0-7506-5479-1.50004-2
9. Batavia, M. (2006). Strength, Power, and Endurance Training. Contraindications in Physical Rehabilitation,154-202. doi:10.1016/b978-141603364-6.50019-7